Breast Augmentation Basics A Plastic Surgeon Explains 88218

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Breast augmentation is not a one-size-fits-all operation. It is a set of choices that shape your body, your comfort, and your daily routine for years. When patients sit in my consultation room, we start with goals, then work backward through anatomy, implant options, incision placement, and recovery. Along the way, I translate medical trade-offs into plain language. If you understand the why behind each decision, your results tend to look and feel more like you.

I have practiced plastic surgery long enough to see trends rise and fall, and to watch how small planning details ripple into outcomes months later. Most women do best with an approach tailored to their chest wall shape, tissue thickness, and lifestyle. A runner with thin tissues and mild asymmetry needs a different plan than a mother of three who has deflated volume after breastfeeding. A meticulous plan up front reduces revisions later.

What breast augmentation can and cannot do

Augmentation can increase size, restore lost volume after weight change or pregnancy, and create a more balanced silhouette. It can also make clothing fit more predictably. What it cannot reliably do is lift a significantly drooping breast on its own. If the nipple sits well below the fold under your breast, you likely need a lift, sometimes in the same operation.

It is also important to frame expectations. Symmetry improves but is not perfect, since natural ribcage and muscle differences persist. Cup sizes vary by brand, so I talk in centimeters and base widths rather than letters. If you bring favorite photos, I will ask what you like about shape and fullness rather than just size, then measure your base diameter to find implants that match your frame.

Who makes a good candidate

Breast augmentation is elective, which means the best patients choose it for themselves, not for a partner or social pressure. Good candidates share a few patterns.

  • Stable weight for several months and no pregnancy or breastfeeding planned in the near future
  • Nonsmoking status or willingness to stop nicotine well before and after surgery
  • Realistic goals and an understanding of scar placement and postoperative limits
  • No active infections, uncontrolled medical problems, or untreated mood disorders
  • Willingness to follow instructions on activity, underwire timing, and imaging follow-up

I often see young professionals in their 20s and 30s, mothers done having children, and women in their 40s to early 50s returning to a shape they miss. Age alone is not the issue. Health, tissue quality, and clarity of goals matter more.

Implants vs fat transfer

There are two main ways to add volume. Implants deliver the most predictable size and shape. Fat transfer moves your own fat, usually from the abdomen or flanks, to the breast through small cannulas.

Implants are best when you want a clear size increase, defined upper fullness, or you have very little breast tissue to start. They come in many base widths and projections to match anatomy. For underwater swimmers, yoga practitioners, or people who prefer stable, one-and-done results, implants fit well.

Fat transfer works when you want a subtle bump, softer feel, and zero implant maintenance. It is also helpful to smooth edges around an implant or improve contour irregularities. The trade-off is variability. Not all the transferred fat survives. In healthy nonsmokers, roughly 50 to 70 percent stays long term. That means if you need a full cup size increase, often you need more than one session and enough donor fat to harvest safely. Mammograms remain effective after fat transfer, though the radiologist should know your history, since tiny benign oil cysts can appear.

In my practice, I will sometimes combine the two: an implant matched to the ribcage geometry plus a thin layer of fat to soften borders and enhance cleavage. This requires careful technique to avoid pressure on the implant pocket.

Saline, silicone, and how they feel

Modern implants have silicone shells. Inside, they are either filled with sterile saline or cohesive silicone gel. Both are safe and FDA approved for augmentation in adults. The decision hinges on feel, maintenance, and body type.

Saline has a slightly firmer, bouncier feel and can show ripples if you have thin tissues, especially near the cleavage or along the side of the breast. The upside is that a rupture is obvious. The implant deflates within days and the saline absorbs harmlessly. Replacement is straightforward. I may use saline in patients with more tissue coverage or those who value the peace of mind of a visible failure.

Silicone gel feels more like natural tissue, especially the newer cohesive gels. It hides ripples better and can be more forgiving in thin patients. The trade-off is that rupture is often silent. The shell can break but the gel stays within the capsule around the implant. For this reason, the FDA suggests periodic imaging to check integrity. I discuss ultrasound every 1 to 2 years in the office and MRI every 5 to 6 years if concerns arise. Not all patients do this on a perfect schedule, but it is worth knowing the recommendation.

Longevity for both types sits in ranges, not hard expiration dates. Many implants last over 10 years. Published 10-year rupture rates vary by brand and model, with ranges around 7 to 10 percent for silicone and similar or slightly higher for saline. Capsular contracture, which I will explain shortly, rises over time and is the most common reason for revision.

Shape, size, and projection

Implants come in round and anatomical shapes. Round implants provide even fullness. When upright, the gel settles and you still get a natural slope, but with more upper pole fullness if you choose a higher projection. Anatomical, often called teardrop, aim to mimic a natural breast with more fullness low and less high. They require a textured shell to prevent rotation in most designs, and texture carries risks that have shifted practice toward smooth, round implants for most patients. With the newer cohesive gels, round implants can often achieve a similar look without the rotation concern.

Sizing is a blend of measurement and artistry. We measure base width, soft tissue thickness, and the distance from nipple to fold. Then I use sizers in a soft bra and review 3D imaging when helpful. Most women end up between 200 and 375 cc for a subtle to moderate change. Petite frames with narrow chests often look best in the 180 to 300 cc range. Larger volumes exist, but I caution against chasing a number without respect for skin stretch, long-term sagging, and activity level.

Projection matters more than many realize. The same base width can carry low, moderate, or high projection, which changes how far the breast moves forward. A marathoner may prefer moderate projection to reduce bounce, while someone seeking more rounding in clothing might like a higher projection with a careful pocket to avoid the stuck-on look.

Incisions and placement options

Surgeons place implants through small incisions and then put them either above or below the pectoralis major muscle. Scar location and pocket depth influence shape, pain, and future maintenance.

  • Inframammary fold, a short incision hidden in the crease under the breast, offers precise control and usually heals with the least visible scar over time
  • Periareolar, placed at the edge of the areola, can blend well if you have a clear color change, though it may slightly increase nipple sensation changes and bacteria exposure from ducts
  • Transaxillary, hidden in the armpit, avoids scars on the breast, but pocket control is more difficult, and revisions may need a second incision
  • Transumbilical for saline only, rarely used, since it limits control and can complicate later adjustments

As for pocket position, subglandular, or above the muscle, heals faster and avoids animation deformity when flexing the chest, but it shows ripples more and may have a higher contracture rate in thin patients. Submuscular, or partial submuscular using a dual-plane technique, adds coverage in the upper pole and often looks more natural in lean frames. It can reduce contracture risk and mammogram interference, though breast imaging is effective in both when done by experienced technicians. I select the plane based on tissue thickness at the upper pole and lifestyle. Professional weightlifters struggle with submuscular motion, while someone with very thin coverage benefits from it.

Capsular contracture, rupture, and other risks

Your body forms a capsule around any affordable plastic surgeon implant. In most patients, it stays thin and soft. In some, it tightens and squeezes the implant. Early signs include upper pole firmness, a rounder look, or a breast that sits higher than the other. We grade it from I to IV, with pain and visible distortion at higher grades. Risk ranges differ by factors like hematoma, bacterial biofilm, and pocket choice. Reported rates over 10 years can sit between 5 and 15 percent in many series, sometimes lower with submuscular placement and meticulous sterile technique. If a contracture becomes bothersome, surgical capsulectomy or capsulotomy with implant exchange helps. I also consider pocket change and antibiotic irrigation at revision.

Rupture behaves differently by fill type. As mentioned, saline deflates quickly and is obvious. Silicone gel rupture is often silent. Modern cohesive gels hold shape better, and the gel usually stays within the capsule. Leakage outside the capsule is uncommon but can cause inflammation. That is why we use imaging when suspicion arises. Replacement after rupture is standard, with cleanup of any gel and confirmation that tissues are healthy.

A separate and rare risk, breast implant associated anaplastic large cell lymphoma, or BIA-ALCL, is a cancer of the capsule around the implant, not of breast tissue itself. It has been linked mainly to macrotextured implants. Lifetime risk estimates have ranged from roughly 1 in 2,500 to 1 in 30,000 depending on the specific textured device. With smooth implants, current data suggest the risk is extremely low. The main sign is late swelling from fluid around the implant, often years after surgery. Any new, persistent swelling warrants evaluation with ultrasound and fluid testing. Treatment is usually total capsulectomy and implant removal, with good outcomes when caught early. We review this candidly so you can make an informed choice.

Some women report a constellation of symptoms they attribute to implants, often called breast implant illness. Fatigue, brain fog, joint pain, and rashes are common complaints. Large studies have not identified a single cause, and symptoms overlap with many conditions. Still, patient experiences matter. When symptoms persist after workup, some choose implant removal with or without capsulectomy. A subset report improvement. Counseling here centers on uncertainty and shared decision-making rather than promises.

Other general surgical risks apply: bleeding, infection, scarring issues, anesthesia reactions, and changes in nipple or skin sensation. Most sensation changes improve in months, but a small percentage stay altered. Nipple hypersensitivity is as common as numbness in the early weeks. Rarely, a milk duct leak can cause a small collection if surgery follows soon after breastfeeding, which is why I ask for a pause after weaning before operating.

How I plan size and symmetry in the office

A common story: a woman with a narrow 12 cm base diameter, mild rib flare on the right, and wish for a natural C in fitted tops. She has a tight skin envelope after weight loss and limited upper tissue thickness. On measurements, a 280 cc moderate plus profile matches her base width. Because she is thin, I favor a dual-plane pocket for coverage. In the office, we use a soft bra and sizers in the 250 to 300 cc range to test clothing. She likes the 270 to 290 cc look. On the table, I upsize the fuller side by 15 cc to offset natural left-right differences. Years later, she still looks balanced, and the edges feel soft.

This is the level of detail you want from your cosmetic surgeon. Sizing by photographs or cup letters alone fails because a 300 cc implant on a petite person can look the same as 400 cc on a wider chest, and bra brand sizing is inconsistent. A plastic surgeon trained in breast work will speak in base widths, tissue pinch thickness, and fold positions. Those terms signal a measured plan.

Anesthesia, pain, and the day of surgery

Most augmentations take about one hour when done alone, longer if combined with a lift or fat transfer. General anesthesia is standard. I inject numbing medication around the nerves that feed the breast and place long-acting local anesthetic into the pocket. Many patients wake up surprised by how manageable early soreness feels. Pain tends to peak in the first 48 hours, then eases. Muscle tightness rather than skin pain dominates in dual-plane pockets, like the ache after a heavy workout.

I do not routinely use drains for straightforward augmentations. A small surgical bra or soft sports bra provides support without heavy compression. The incisions get closed in layers with absorbable sutures plastic surgeon near me and surgical glue outside. You go home the same day with a responsible adult. Prescriptions include a short course of pain medication, anti-nausea medication, and sometimes a muscle relaxant. Many patients do well on alternating over-the-counter acetaminophen and ibuprofen after the first day.

Recovery timeline that aligns with real life

Desk work returns within 3 to 5 days for most. Light cardio like walking or a gentle stationary bike starts at day 3 to 5 if balance feels good. I hold off on running and bouncing movements for about 3 to 4 weeks to protect the pocket. Upper body weights wait 4 to 6 weeks, then ramp gradually. Someone with subglandular placement may move a bit faster, while dual-plane patients need patience with chest workouts to avoid animation settling early. Heavy lifting at a job can require a modified return plan, which I write for employers when needed.

Showers resume after 24 to 48 hours, depending on dressings. Underwire bras wait 6 weeks so the wire does not irritate the healing fold. Scars mature over 12 to 18 months. I recommend silicone gel or sheets once the skin has sealed, sun protection, and scar massage when tenderness allows. A small percentage of scars get raised or wide. Early steroid injections and medical grade silicone can help. If an incision runs near the areola, pigment differences usually make the scar less visible.

Swelling follows a predictable arc. At 1 week, the breasts sit higher and feel tight. By 6 weeks, they soften and drop into a more natural position. Side sleeping is fine after the first couple of weeks if comfortable, but stomach sleeping waits longer, usually around 6 to 8 weeks after clearance. I will guide the timing to your comfort and pocket stability.

How pregnancy, breastfeeding, and imaging fit in

Most women can breastfeed after augmentation, especially if the incision is in the fold and the gland is not widely divided. A periareolar cut may slightly increase the chance of duct disruption or decreased sensitivity, but many still breastfeed successfully. That said, pregnancy changes the breast regardless of prior surgery. If you plan pregnancy soon, it can be wise to wait, since volume and skin stretch may shift your result.

Mammograms remain effective. Tell your imaging center that you have implants so they perform implant displacement views, often called Eklund views, which push the implant back and pull the tissue forward. Ultrasound plays a larger role now, both for routine breast imaging in younger women and for implant checks. MRI gives the highest detail for silicone rupture but is not needed on a strict schedule for everyone. In my Michigan practice, most imaging centers are well versed in augmented breasts. If you see a plastic surgeon Michigan based, they should know which local imaging teams have strong experience so you can plan exams confidently.

How much it costs and what affects pricing

Costs vary by region and facility. In the Midwest, a straightforward augmentation with silicone implants often falls in the 6,000 to 9,000 dollar range, all-inclusive of surgeon, anesthesia, and facility fees. Saline can be a few hundred dollars less. Add a lift, and the range extends upward, sometimes into the 10,000 to 13,000 dollar band depending on complexity. Revision surgery tends to cost more because of scar tissue work and possible capsulectomy.

Beware of teaser prices that exclude facility or implant fees. Also ask what is included in aftercare. I bundle routine follow-ups for a year and include a limited warranty discussion so you understand what the manufacturer covers for rupture or capsular contracture, and what your out-of-pocket looks like if a problem arises after the first year. A reputable cosmetic surgeon will break this down clearly.

Choosing the right surgeon

Experience with breast surgery is key, not just general plastic surgery exposure. Review before-and-after photographs that match your body type, not just dramatic transformations. Look for consistent nipple position, smooth upper borders without step-offs, and natural slope. Ask how the surgeon handles asymmetry, what implant brands and styles they favor and why, and how many revisions they perform for their own patients. Some revision work is inevitable over years, but a high, early revision rate may signal problems with pocket control or sizing philosophy.

If you live in or near Michigan, seeing a plastic surgeon Michigan patients recommend can help with logistics, especially for follow-up imaging and any rare longer-term issues. Regional surgeons also tend to know how local lifestyles affect choices. I see more runners and lake swimmers in the warm months, which colors my advice on bounce control and bra support.

A few scenarios that change the plan

Athletes with low body fat and thin soft tissue coverage often do best with a dual-plane pocket, slightly lower projection, and a moderate size that stays under the tissue envelope. I also build in extra time before a return to heavy upper body work. I might add a small fat graft at a second stage if ripples show.

Mild tuberous breast shape, where the fold sits high and the base is tight, requires internal releases and sometimes lower pole expansion. An implant alone may look tight and ball-like if the fold is not managed. These cases do well in experienced hands, but they are not quick in-and-out procedures.

Post-pregnancy deflation with mild sag can be addressed with a carefully chosen implant and a dual-plane pocket that allows the lower breast to fill. If the nipple sits at or above the fold, you may avoid a lift. If the nipple points down or hangs well below the fold, adding a lift saves you from chasing volume to fill skin that really needs tightening. Choosing a modest implant with a lift often looks better and ages better than a large implant alone.

Asymmetry more than half a cup size typically needs different implant sizes or profiles, and sometimes fold adjustments. Trying to camouflage a clear skeletal difference with volume alone rarely holds up under clothes that fit closely. I set expectations early here and show examples of what symmetry means in the real world.

A word on maintaining results

Implants do not stop aging. Gravity, skin elasticity, and weight shifts still act. Good support bras during exercise help. Stable weight matters as much as the initial surgery. If you gain or lose 20 pounds, the breast changes. Pregnancy will still remodel tissue. Many patients enjoy stable results for a decade or more, then see me for a small implant exchange, minor lift, or pocket adjustment. That rhythm is normal. Planning for longevity at the start, avoiding overfilling, and protecting tissue quality pays dividends.

If you ever notice sudden swelling, a shape change that does not settle, new pain on one side, or signs of infection like redness and warmth, call your surgeon. Most issues are small and easy to correct when addressed early. Serious problems are rare, but vigilance and an open line of communication matter.

What the first consultation should feel like

Expect a conversation, not a sales pitch. We will take a medical history, examine tissue thickness and ribcage shape, and discuss goals. Then we will measure base width and nipple positions, talk through incision choices, and pick a preliminary size range. I will show you how different projections look on your frame. We will also cover activity timelines, time off work, and childcare logistics. Many of my patients bring a partner or friend to absorb details. That is fine, as long as the final choice is yours.

I encourage you to ask about capsular contracture rates in the surgeon’s hands, pocket preferences and why, and how they monitor silicone implants long term. Ask how they handle rare concerns like BIA-ALCL, and whether they offer implant removal if you ever want it. You deserve plain answers and a sense that the surgeon will be there years later, not just the day of surgery.

The bottom line from an operating room perspective

Augmentation succeeds when planning lines up with anatomy and life. That means choosing implants that fit the chest base, respecting tissue limits, placing scars where they hide well on your skin, and setting a recovery schedule that matches your job and family needs. It means understanding how saline and silicone differ in feel and maintenance, and what pocket placement does to shape now and during movement.

Patients often tell me the result feels less like a medical device and more like a return to their own body. That is the goal. If you are considering cosmetic surgery of the breast, sit down with a board-certified plastic surgeon who will measure, listen, and be transparent about risks and options. Whether you meet a cosmetic surgeon in a large city or a plastic surgeon Michigan based near your home, the principles remain the same. Balanced choices up front create natural results that hold up in a mirror, in motion, and in daily life.

Aesthetic Plastic Surgery & Laser Center, Michelle Hardaway M.D.
Address: 27920 Orchard Lake Rd, Farmington Hills, MI 48334, United States
Phone number: +12482211957

FAQ About Plastic Surgeon


What exactly is a plastic surgeon?

A plastic surgeon is a specialized medical doctor who repairs, reconstructs, or enhances the human body. Trained in molding and shaping tissue, they handle everything from reconstructive procedures (restoring function and appearance after trauma or disease) to elective cosmetic surgeries aimed at altering physical features.


What is the 45 55 breast rule?

The 45/55 breast rule is an aesthetic guideline used in plastic surgery stating that for a youthful, natural-looking breast, roughly 45% of its volume should sit above the nipple and 55% below.


Who is the best plastic surgeon in Michigan?

Several plastic surgeons in Michigan are highly regarded for their expertise, with many, including Dr. Mariam Awada, Dr. Pramit Malhotra, and Dr. Faisal Al-Mufarrej, earning top honors and consistent 5-star ratings for their work in 2026.


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